58-year-old female with history of depression, which is currently being treated with venlafaxine; no depressive symptoms at present. History of ECT; last session 05/16, total of 17 treatments over approximately 8 months. Mild REM sleep behavior disorder. Memory/cognitive complaints for past approximately 5 years, which are becoming more frequent and worsening. Family history of Parkinson’s and/or dementia among mother’s siblings; two of the five with dementia were early-onset, one likely vascular. Nothing abnormal in most recent blood work, other than total cholesterol (236). Blood pressure is normal. History of breast cancer in 2012, treated with bilateral mastectomy; no chemo or radiation. Fatty liver disease (non-alcoholic). No alcohol/drug use; no current tobacco use. Early macular degeneration (dry type).

Formerly worked as a systems analyst/programmer and project manager, computer systems trainer, network administrator. 14 years’ education, as well as avid pursuit of a wide variety of interests and hobbies. Lives alone; recently requires assistance with some activities such as bill-paying.

Underwent neuropsychological testing in 07/16. Dementia Rating Scale -2 result: 134/144. Report states that “This pattern of performance is suggestive of very subtle frontal and subcortical system involvement” and “Given the presence of REM sleep behavior disorder and her family history, the possibility of underlying disorder such as Parkinson’t disease should be ruled out, and should continue to be monitored. Similar cognitive findings can be observed with Parkinson’s disease.” Repeated testing to be conducted in one year.
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EEG was performed in 08/16 at Mayo in Rochester. Verbatim report follows:

CLINICAL INTERPRETATION: The short-term video EEG shows a moderate degree of intermittent focal slowing over the left frontotemporal head region. This finding is consistent with a moderate disturbance of cerebral function or focal lesion involving this region. No clear epileptiform discharges are seen.

REPORT: This short-term video EEG recording during wakefulness contains 9-10 Hz background activity. Intermittent, moderate amplitude, polymorphic 1-2 Hz delta slowing is present over the left frontotemporal head region. No abnormal activity occurred during photic stimulation. Hyperventilation was not performed due to concerns about ischemia. During the recording, the patient fell asleep spontaneously. No additional activation was seen during sleep. The EKG was unremarkable.

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What, if anything, should be done to follow up on this EEG? If there’s a neurologist reading this, what would you suggest for this patient? What questions should she ask of her providers?

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Dr Mahaveer

hi
it does seems that you have a parkinsons. Though the symptoms and the reports do no match 100 % that of a parkinsons,but many variants of parkinsons present in this way.You should ask your neurologist about such type of parkinsons variants and get started with appropriate medicines

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October 16, 2016 12:01 pm

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shw12

HI
ITS LESS LIKELY TO BE A PARKINSONS DISEASE. THE SYMPTOMS ARE NOT CLASSICAL OF A PARKINSONS AND AGE-RELATED CEREBRAL PHYSIOLOGICAL CHANGES SEEM TO BE MORE LIKELY THE CAUSE. MANY OTHER NEUROLOGICAL CONDITIONS CAN MIMICK THESE FINDINGS AND SHOULD BE RULED OUT. DOESNT SEEM TO BE A ISSUE THAT SHOULD BE WORRIED ABOUT

What, if anything, should be done to follow up on this EEG? If there’s a neurologist reading this, what would you suggest for this patient? What questions should she ask of her providers?

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October 16, 2016 1:39 pm

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vint1958

No motor symptoms of Parkinson’s at this time. DLB is being considered; however, there is insufficient evidence for that dx at this time. Of more concern is what, if anything, should be done as follow-up to the EEG findings, and what conditions could cause said findings.

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October 16, 2016 2:11 pm

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mrsshalini14

hello there
This related to abnormal cerebral functioning. The electrical impulses and the rhythm in the EEG are disturbed indicating abnormal behavioural symptoms. This is not parkinsons. You should ask the neurologist about the abnormal electrical impulses and the ways to make them uniform

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October 16, 2016 3:52 pm

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Dr Mahaveer

hi
as per this EEG reading,the brain cells in the frontotemporal region of your brain are sending abnormal impulses resulting in these kind of symptoms. ECT would be ideal in your cases as a treatment modality. only medicines wont be of much help. atleast 5-7 settings of ECT should be given to see good results .
you should ask about this treatment from your providers

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October 16, 2016 4:44 pm

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vint1958

Delta waves are not normally seen in the waking state in adults. Their presence can indicate, as specified in the report, a lesion in the area or “a moderate degree of cerebral dysfunction”. ECT seems pointless, at best, given the lack of depressive symptoms at this time and the certain exacerbation of cognitive issues that would result. ‘ Patient’s main concern is decline in cognitive function and memory and whether the issues documented by the neuropsychological testing, coupled with the EEG results, would warrant further investigation. For example, should further imaging studies be pursued? Which ones? Would QEEG provide more… Read more »

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October 16, 2016 7:58 pm

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Dr Mahaveer

Hi
QEEG won’t give much of additional information than what this EEG has already provided.
Instead,an MRI of brain or a CT with contrast study will help localise and differentiate an organic lesion in the frontotemporal region. Follow up EEGs can be done later depending upon the progress of symptoms.
Thanks